Mild Exercise Good for the Critically Ill

FRIDAY April 9, 2010 -- Critically ill patients in the intensive care unit may reduce their use of sedatives and speed their recovery by engaging in mild exercise, a new study has found.

The amount of prescription sedatives had to be slashed by half to enable patients to exercise, which reduced the amount of muscle weakness caused by spending long periods of time in bed, and shortened ICU recovery times by as much as two to three days, the researchers said.

Reduced use of sedatives in patients who exercised also led to fewer bouts of hallucination and delirium, according to the report published online April 9 in the journal Archives of Physical Medicine and Rehabilitation.

The study included 57 patients in the medical intensive care unit (MICU) at Johns Hopkins. The 30- to 45-minute exercise sessions were carefully guided by trained physical and occupational therapists and included any combination of either leg or arm movements while lying flat in bed, sitting up or standing, or walking slowly in the ICU corridors.

Some of the patients who did the exercises were attached to life support equipment, such as mechanical ventilators, the study authors noted.

The use of drowsiness-inducing benzodiazepines dropped to only 26 percent of patient days in the MICU in the four months after the start of the exercise program, compared to 50 percent of patient days in the three months before the start of the program.

Daily doses declined still further. Before early exercise was introduced in the MICU, half of the patients received more than 47 milligrams of midazolam and 71 milligrams of morphine per day, compared with less than 15 milligrams of midazolam and 24 milligrams of morphine after the exercise program began.

There was also a significant decline in patient delirium, which can include hallucination or being unaware of one's surroundings. The number of clear-thinking days among patients increased from 21 percent to 53 percent after they began exercising, the study found.

"Our work challenges physicians to rethink how they treat critically ill patients and shows the downstream benefits of early mobilization exercises," project leader and critical care specialist Dr. Dale Needham said in a Hopkins news release.

"Our patients keep telling us that they do not want to be confined to their beds, they want to be awake, alert and moving, and engaged participants in their recovery," said Needham, an associate professor at the Johns Hopkins University School of Medicine. "Patients are not afraid of exercising while they are in the ICU, and they are embracing this new approach to their care in the ICU. It actually motivates them to get well and reminds them that they have a life outside the four walls surrounding their hospital beds."